Dementia

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KEY POINTS

• Dementia is a gradual loss of the ability to think, remember, reason, and plan.
• There is no cure for most forms of dementia. Medicines may slow down the memory loss and function.
• Involve the person in decisions about the care they receive if possible.
• Talk with your healthcare provider about help at home or about adult day care centers, mental health services, transportation, and nursing facilities.

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What is dementia?

Dementia has many causes and typically results in a variety of symptoms. These symptoms can result in a gradual loss of the ability to think, remember, reason, and plan. People with advanced or severe dementia are not able to care for themselves. Their behavior and personality may also change.

Dementia is not a normal part of aging. As people get older, they may forget names, phone numbers, or where objects are. However, healthy older people usually remember or figure out how to look up a forgotten name or address. People with dementia forget things far more often. They also have much more trouble with problem-solving and thinking things through.

What is the cause?

Dementia happens when brain cells stop working correctly. The cells can no longer store memories or process information in the normal way. Conditions that can cause dementia include:

• Alzheimer's disease (the most common cause)
• Stroke, when blood flow to part of the brain is suddenly slowed or stopped
• Head injury
• Multiple sclerosis, a disease of the central nervous system (the brain and spinal cord)
• Parkinson's disease, which also causes the brain to lose the ability to control muscle movements
• Alcohol or drug abuse
• AIDS
• Viral infection of the brain
• Huntington's disease, a rare nervous system disease that causes nerve cells in the brain to slowly waste away

As the disease causing the dementia gets worse, more brain function is lost.

What are the symptoms?

Many symptoms are possible with dementia. At first, symptoms may be mild. However, as time passes, symptoms may worsen and include:

• Memory problems, such as trouble remembering recent events, people, places, times, or dates
• Poor judgment and not being able to understand the results of some actions
• Decline in thinking, problem solving and reasoning ability (for example, not being able to figure out the correct order in which to put clothing on)
• Trouble following instructions or staying with a task, which causes problems paying bills, fixing meals, shopping, or taking medicines
• Lack of emotions, lack of interest in what is going on, less participation in activities previously enjoyed, or withdrawal from other people
• Loss of appetite or interest in food
• Less concern about looking neat and being clean
• Irritability
• Wandering away from home or getting lost
• Believing things that are not true such as that someone is stealing money or belongings or that family members are not who they say they are

As the disease gets worse, it causes problems with control of the body, such as:

• Being unable to control bowels or bladder
• Being unsteady while walking, which can lead to falls
• Forgetting how to feed yourself or having trouble chewing and swallowing
• Having a hard time speaking and thinking of the right words and eventually becoming unable to speak
• Not recognizing close friends and family members

How is it diagnosed?

The healthcare provider will do a physical exam to find out whether there is a condition that could cause the symptoms. The provider will ask about symptoms, past medical history and medicines, and whether there is drug or alcohol use. Tests may include:

• Blood tests
• EEG (electroencephalography): A test which measures and records the electrical activity in the brain
• An ECG (also called an EKG or electrocardiogram), which measures and records the heartbeat
• CT scan, which uses X-rays and a computer to show detailed pictures of the brain
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the brain
• Tests to check concentration, memory, understanding, and decision making

How is it treated?

There is no cure for most other causes of dementia. Rarely, if a viral infection in the brain causes dementia, treating the infection may cure or improve the symptoms.

Some medicines may help slow down the loss of memory and function, but the medicines do not cure dementia. Don't expect big improvements when these medicines are given. Medicine may not help people who have severe dementia. Talk to the healthcare provider about the risks and benefits of these medicines.

Dementia usually gets worse over time. The healthcare provider can explain more about what to expect. Making changes in the home and in family routines is important to keep the person with dementia safe. Care may be needed at home, or the person may need to live in a facility where they can get special care. Nursing facilities, assisted living, or adult day care centers are the most common types of facilities used for this purpose.

How can I help take care of someone with this disease?

If possible, the person should be involved in decisions about the care they need or want to have. A durable power of attorney for medical and financial matters should be signed before they become unable to make decisions. If desired, a living will should be made out as well. Ask the healthcare provider for more information about these documents in your state.

The prospect of living a long time with the need for total care and supervision may feel overwhelming. Caregivers may become emotionally and physically worn out if they have no help or no time for themselves. Support groups for caregivers, family, and friends can help with reassurance, emotional support, and learning about the disease.

Community resources are very important. To find out about these services, talk with the healthcare provider, county health department, or visiting nurses association.

• Social workers can find and organize help, including possible financial aid.
• Home healthcare agencies provide nurses, medical social workers, health aides and therapists to help with care.
• Training programs can help family and friends who care for a person with dementia.
• Out-of-home services include adult day care centers, mental health services, transportation, and nursing facilities.